What is the Difference Between Hospice and Palliative Care?

Death seems to be out of the closet. Since COVID, there are more open and frank discussions about death and dying. Death cafes exist, as do a growing number of death douhlas. Hospice and palliative care programs are at an all-time high in use. And now there is Medical Aid in Dying. People are concerned about quality of life, aging-in-place well, and dying when the time comes as peacefully as possible. In this milieu, there is growing ambiquity about “Hospice” and “Palliative Care”. 

The confusion arises because Hospice programs and Palliative Care services both provide the type of care this is called “palliative”; that is, an approach to caring for human beings that is deeply person-centered, holistic, quality-of-life oriented, and skilled in pain and symptom management. The domains of palliative care include the physical, emotional, social, cultural, spiritual, and ethical. Advanced directives and conversations about What 

Matters Most are important, as is team-based care.So what is the difference? HOSPICE is a structured program of care, covered by insurance, and directed at end-of-life, defined as “a life expectancy of six months or less, if the disease runs its normal course.” This prognosis is an admission criteria only, not a schedule to die. It is re-evaluated periodically for continuance on the Hospice program. 

Cure-oriented treatments are discontinued on Hospice, as the care shifts to palliative care exclusively. The formal Hospice program covers physician, nurse, socialwork, home health aide, pastoral care, volunteers, and bereavement care, as well as a 24/7 on-call nurse. Family caregiving is needed for extended personal care. In Hospice, all medications related to the terminal illness are covered, as is medically necessaryequipment in the home.

PALLIATIVE CARE services, unlike Hospice, refers to medical services during the advanced stages of illness, earlier than Hospice. It is considered appropriate at any stage of serious illness, and can be received as alongside ongoing cure-oriented or disease-modifyingtreatments. Palliative care “specialists” have advanced credentialling, and can receive referrals from other health care providers. Like Hospice, maximizing quality of life is core.

Palliative care consultation services exist in area Hospitals, and are available in home and outpatient settings through Saratoga Hospital. There is no existing insurance reimbursement for palliative care as a program, but individual palliative care providers can bill insurances directly or through a Hospital.

The best way to maximize the benefits of Hospice and Palliative Care is to get palliative care early in the process of advancing serious illness, then consider Hospice once the life expectancy time frame has been established. To access services, a physician referral is required. 

Since most people are not familiar with a natural dying process, Hospice and Palliative 

Care can be educational as well as medically and emotionally crucial. Guidance is provided, for example, on the use food and drink when it comes to an actively dying end phase, as well as the best use of medications for symptom management. Caregiver support and use of volunteers also make the journey meaningful for both the seriously ill person and their loved ones. We each will be facing decisions about what constitutes a “good death” for ourselves, and how our own personhood can be enhanced during all phases of illness. So maximizing Hospice and Palliative Care looms large in the current environment of chronic and terminal illnesses.

Phil Di Sorbo is the former Executive Director of Community Hospice, Palliative Care Manager of Ellis Medicine, and Director of the Senior Life Transitions Program at the Saratoga Senior Center. He currently assists primary care practices in integrating palliative care principles, and he coordinates the Community Hospice Africa Partnership Program. He can be reached at pdisorbo@fairpoint.net